| North Shore Center Llc | |
|
10303 N Port Washington Rd #203 Mequon WI 53092 | |
| (262) 241-5955 | |
| (262) 241-5926 |
| Full Name | North Shore Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10303 N Port Washington Rd, Mequon, Wisconsin |
| Authorized Official Name and Position | Michael Mazius (DIRECTOR) |
| Authorized Official Contact | 2622415955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Shore Center Llc 10303 N Port Washington Rd #203 Mequon WI 53092 Ph: (262) 241-5955 | North Shore Center Llc 10303 N Port Washington Rd #203 Mequon WI 53092 Ph: (262) 241-5955 |
| NPI Number | 1780755389 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3173569282 |
|---|---|
| Medicare Enrollment ID | O20050629000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780755389 | NPI | - | NPPES |
| 42204700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Michael A Mazius |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114098712 PECOS PAC ID: 7113963224 Enrollment ID: I20110505000400 |
| Provider Name | Judy Blumenfeld |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891868253 PECOS PAC ID: 7911168414 Enrollment ID: I20120410000368 |
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